Thu, 14 Feb 2013 14:14 CST
Just how much influence such gifts had on doctors has long been debated (although the research suggests it did have a significant impact … why else would the drug companies put so much money into it?). But regardless, sound medical research published in a reputable medical journal should have much more influence …
A pen with a drugmaker’s name emblazoned on the side couldn’t possibly persuade a physician to prescribe a drug more than clinical data published in a medical journal.
Yet, what many people do not understand is that much of the scientific research published in journals is bought-and-paid-for by the drug industry as well.
A far more covert – and far more influential – practice than showing up at a physician’s office with a free pizza and a duffel bag full of coffee mugs, by controlling medical research itself the drug industry can make it virtually impossible for a well-meaning physician to decipher the truth about the medications he or she is prescribing to you.
Most Medical Journals Depend on Big Pharma Advertising Dollars
In The American Scholar, author Harriet Washington writes:1
“… while we still gravely debate whether physicians’ loyalties can really be bought for a disposable pen or a free lunch, the $310 billion pharmaceutical industry quietly buys something far more influential: the contents of medical journals and, all too often, the trajectory of medical research itself.
… Flimsy plastic pens that scream the virtues of Vioxx and articles published in the pages of The New England Journal of Medicine would seem to mark the two poles of medical influence. Scarcely any doctor admits to being influenced by the former; every doctor boasts of being guided by the latter.
In fact, medical-journal articles are widely embraced as irreproachable bastions of disinterested scientific evaluation and as antidotes to the long fiscal arm of pharmaceutical-industry influence.
And yet, ‘All journals are bought – or at least cleverly used – by the pharmaceutical industry,’ says Richard Smith, former editor of the British Medical Journal …”
It starts with advertising dollars, as pharmaceutical ads can make up 97-99 percent of a medical journal’s advertising revenue. As the featured article reported:
” … medical journals themselves advertise to drugmakers, flooding the pages of pharmaceutical-industry publications such as Medical Marketing and Media to vie for the attentions of Big Pharma. TheJournal of the American Medical Association (JAMA) bills itself in advertising as ‘a priceless audience at a price you can afford,’ while the Annals boasts: ‘With an audience of more than 90,000 internists (93 percent of whom are actively practicing physicians), Annals has always been a smart buy.’
In 2003, drug companies spent $448 million on advertising in medical journals. The ads promote not only drugs but also subsidized seminars and “training opportunities” that usually take place in tropical locations.
Of course, oftentimes the ads are only agreed upon if there will also be a positive mention of the product in an editorial piece; sometimes the drug maker will even have their own writers generate the content! It has been calculated that the return on investment on medical journal ads is between $2.22 and $6.86 for every dollar spent, with larger and older brands at the higher end.
Long-term returns may be even higher when you consider that one ad viewed by a physician could result in hundreds or even thousands of drug purchases, based on the prescriptions he or she writes.
At least certain medical journals are attempting to regain their unbiased reputations; in 2011 the journal Emergency Medicine Australasia announced it would no longer accept pharmaceutical advertisements, citing growing evidence that the drug industry “distorts research findings and engages in dubious and unethical publishing practices.”
Why Most Medical Research Cannot be Trusted
The sad truth is, there’s no easy way to determine what you can trust when it comes to medical research and official treatment guidelines. So much of it has been tainted by financial conflicts of interests. It’s well known that studies funded by industry or conducted by researchers with industry ties tend to favor corporate interests.
That’s why it probably comes as no surprise that many so-called “experts” are very much on the drug industry’s payroll — but they masquerade as independent medical experts or even state officials during their “day jobs.”
It is, by the way, 100% legal for drug companies to pay medical professionals to promote their products. The drug industry also often pays the expert medical reviewers who evaluate medications or medical devices for the journals. The featured article continues:2
“Today, medical-journal editors estimate that 95 percent of the academic-medicine specialists who assess patented treatments have financial relationships with pharmaceutical companies, and even the prestigious NEJMgave up its search for objective reviewers in June 1992, announcing that it could find no reviewers that did not accept industry funds.”
The conflict of interest within this practice is obvious, which is why the drug industry often keeps quiet on their actual payments, as do the medical professionals involved. Although many medical, educational and research institutions require faculty members to disclose such potential conflicts of interest, many do not actively monitor employees’ activities.
Financial disclosures are also added into medical journals, but the reader will only learn which company may have paid an expert author, not how much or what other ties to industry they may have. Unfortunately, even if you scour the medical literature to determine what the consensus is on any given medical topic, what you’ll find is an overwhelming preponderance of data in favor of the drug approach that in no way, shape or form reflects the reality of the scientific investigation that went into that specific drug.
How Negative Research Gets a Positive Spin
The fact is, there are many ways to turn an otherwise negative study positive, including choosing study participants who are more likely to benefit from the treatment or even hiding, or simply not publishing, negative results; in fact, researchers of industry-funded studies often sign gag orders that forbid them from publishing, discussing or analyzing data without permission of the funder. According to Marcia Angell, former editor-in-chief of the New England Journal of Medicine (NEJM): 3
“Any reputable journal is at the mercy of what is submitted to it and must choose from whatever comes over the transom. Many studies never see the light of day because their findings are negative. There is a heavy bias toward positive studies, and this negative bias is a real problem. A company may conduct 1,000 trials; if two are positive, they get FDA approval and are published. The other 998 never see the light of day. In fact, half of all study data is never published.”
In a tongue-in-cheek essay in the British Medical Journal, titled “HARLOT – How to Achieve Positive Results Without Actually Lying to Overcome the Truth,”4 it’s wittily explained exactly how industry insiders can help make their drugs look good:5
- “Comparing their drug to a placebo. A placebo, such as a sham or ‘sugar’ pill, has no active ingredient, and, although placebos may evoke some poorly understood medical benefits, called the ‘placebo effect,’ they are weak: medications tend to outperform placebos. Placebo studies are not ethical when a treatment already exists for a disorder, because it means that some in the study go untreated. However, if you care only that your new drug shines in print, testing against placebo is the way to go.
- Comparing their drug to a competitor’s medication in the wrong strength. Too low a dose makes the rival drug look ineffective. Too high a dose tends to elicit worrisome side effects.
- Pairing their drug with one that is known to work well. This can hide the fact that a tested medication is weak or ineffective.
- Truncating a trial. Drugmakers sometimes end a clinical trial when they have reason to believe that it is about to reveal widespread side effects or a lack of effectiveness – or when they see other clues that the trial is going south.
- Testing in very small groups. Drug-funded researchers also conduct trials that are too small to show differences between competitor drugs. Or they use multiple endpoints, then selectively publish only those that give favorable results, or they ‘cherry-pick’ positive-sounding results from multicenter trials.”
Did You Know the Drug Industry Also Pays Ghostwriters?
One cross-sectional survey found that more than 20 percent of articles published in six leading medical journals during 2008 were likely written by honorary and/or ghostwriters.6 For medical journals, ghostwriting usually refers to writers sponsored by a drug or medical device company, who make major but uncredited research or writing contributions.
The pharmaceutical company hires a medical education and communications company, which is a company paid almost exclusively by pharmaceutical companies to write articles, reviews, and letters to editors of medical journals in order to cast their products in a favorable light. (Since they pay substantial amounts to have these articles written, it automatically implies that it will be written to their specifications.)
Once the article is written to their satisfaction, the pharmaceutical company then starts “shopping around” for an academic physician or physicians who are well known in the field, encouraging them to put their name on the article.
From there, they “massage” the article past peer review in one of the more prestigious medical journals, preferably one that strongly influences practicing doctors. Once the article is published, the pharmaceutical company then purchases tens of thousands of reprint copies to be distributed to doctors’ offices by their pharmaceutical representatives. The unsuspecting doctor thinks the study is reliable since it clearly appears to be written by a leading name in the field and has been published in a prestigious peer-reviewed medical journal.
Why would medical journals play along with this apparent sham? Perhaps the primary incentive to play it loose is that it’s very lucrative for them, as the reprints purchased by the pharmaceutical companies for distribution are quite expensive. And medical journals are, after all, for-profit businesses. In some cases, some of the leading publishers have even sunk so low as to publish entire sham journals. The featured article stated:7
“Elsevier publishes 2,000 scientific journals and 20,000 book-length works, but its Australasian Journal of Bone and Joint Medicine, which looks just like a medical journal, and was described as such, was not a peer-reviewed medical journal but rather a collection of reprinted articles that Merck paid Elsevier to publish. At least some of the articles were ghostwritten, and all lavished unalloyed praise on Merck drugs, such as its troubled painkiller Vioxx. There was no disclosure of Merck’s sponsorship.
Librarian and analyst Jonathan Rochkind found five similar mock journals, also paid for by Merck and touted as genuine. The ersatz journals are still being printed and circulated, according to Rochkind, and 50 more Elsevier journals appear to be Big Pharma advertisements passed off as medical publications. Rochkind’s forensic librarianship has exposed the all-but-inaccessible queen of medical publishing as a high-priced call girl.”
How Can You Make Educated Health-Care Decisions?
When your physician prescribes you a medication, even if he or she has reviewed the relevant published data, there is virtually no way to know whether that drug is truly safe or effective. The well from which that data has been drawn has been “poisoned” so that it’s nearly impossible to decipher what is real and what is a fabrication.
Since it is very well established that most prescribed drugs do absolutely nothing to treat the cause of disease, it would be prudent to exercise the precautionary principle when evaluating ANY drug claim, as it will more than likely be seriously flawed, biased, or worse … and, of course, I always advise taking control of your health, which you can easily do by reviewing mycomprehensive nutritional plan that summarizes my 30 years of clinical experience and treating 25,000 patients. I put this together so you can stay well and avoid falling into the dangerous, deceitful traps discussed in this article.
Sources and References